Provider Notice Issued 10/30/2017

Re:Succeeding in the New Managed Care Program Series (#4): How HFS and the health plans will communicate transition details to clients

This is the fourth in a series of notices to help providers succeed with the upcoming enhancement of the Managed Care Program at the Department of Healthcare and Family Services (HFS).

The new Managed Care Program is named “HealthChoice Illinois.”

Beginning on January 1, 2018, newly selected health plans under HealthChoice Illinois will have a contract to begin managing Medicaid client care in every Illinois County (Overview Notice), phased-in according to the program expansion mail schedule. Upgrades built into the program will also help providers participate more easily.

Helping Clients Transition

During the transition to HealthChoice Illinois, the Department will reach out to every participating Medicaid beneficiary directly with information about their status. HFS asks for provider help with this process.

Letters were sent to all those currently enrolled in a FHP/ACA, ICP, or MLTSS managed care health plan to explain their options and opportunities. Sample letters have been posted online, along with their mailing schedule, under the heading “HealthChoice Illinois Transition Information.” The chart below provides a broad overview of how a beneficiary’s current status is likely to be affected:

Client’s StatusProbable Transition

Current plan remainingStay with plan Jan. 1, then 90-day option to change

Current plan exitingAssigned to a new plan Jan. 1, then 90-day option to change

Not in managed care30-day choice period in early 2018, enrolled beginning April 1, then 90-day option to change.

Other aspects of a beneficiary’s status may affect their transition. For more details on differences among client transitions, please see the Department’s overview notice. This also lists the health plans that will be participating in HealthChoice Illinois and health plan options for dual eligible beneficiaries.

Plans will also be separately communicating individually with their clients to help emphasize this information.

HFS designed HealthChoice Illinois to ensure that beneficiaries fully understand their options, and we understand there will be concerns and questions which will need to be addressed. Provider assistance is greatly appreciated.

Understanding More

Articles in the Department’s Succeeding in the new Managed Care series: